A comparison of four culture methods for diagnosing infection in continuous ambulatory peritoneal dialysis

Ludlam, H.; Dickens, Andrea; Simpson, Alex; Phillips, Ian

doi:10.1016/0195-6701(90)90115-5

Cited by 16 publications

(7 citation statements)

References 10 publications

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“…Sonication, freeze-thawing, and deoxycholate treatment of dialysates (136,141) all added substantially to the culture positivity rate. In a recent comparison of distilled water-lysis centrifugation, filtration, mechanical lysis, and bile salt lysis, sensitivities were 81, 74, 74, and 67%, respectively (77). The last two techniques were not recommended because of destruction of bacterial cells, contamination, and inhibition of gram-positive organisms.…”

Section: Clin Microbiol Revmentioning

confidence: 99%

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

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Section: Clin Microbiol Revmentioning

confidence: 99%

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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“…In fact, the ISPD Ad Hoc Advisory Committee has acknowledged that the speed with which a bacteriological diagnosis can be established is of utmost importance [2, 3]. From these perspectives, the broth culture method is justified and probably superior to the relatively labor-intensive lysis-centrifugation technique [9,10,11]. …”

Section: Discussionmentioning

confidence: 99%

Continuous Ambulatory Peritoneal Dialysis Peritonitis: Broth Inoculation Culture versus Water Lysis Method

Chow

Szeto

et al. 2007

Nephron Clin Pract

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Background/Aim: In the setting of empiric antibiotic treatment of peritoneal-dialysis-related peritonitis complications, the speed with which a bacteriological diagnosis can be achieved is of importance. We compare the clinical performance of two culture methods to diagnose the causative microorganisms as suggested by the International Society for Peritoneal Dialysis and the United Kingdom Health Protection Agency. Methods: We prospectively evaluated microbiological cultures of peritoneal fluid samples by the direct broth culture versus water lysis. Samples from 17 consecutive patients with dialysis-associated peritonitis were examined. Results: Of the 17 dialysates cultured, 14 (82.4%) were positive by one of the two methods. The final culture results agreed in 16 of 17 specimens (94.1%). The preliminary organism identification rate by Gram staining with the broth culture method was 70.6%, which was significantly greater than 17.6% by the water lysis method (p = 0.0019). In particular, the broth culture technique demonstrated superior Gram stain performance to identify Gram-positive organisms. Among the 13 dialysate samples positive by both methods, the broth culture method detected organisms faster than the water lysis method (1.3 ± 0.7 vs. 2.6 ± 1.6 days, p = 0.005). Conclusions: Our results support the routine use of the broth culture technique using BacT/Alert blood culture bottles in order to facilitate early streamlining of empiric antibiotic therapy. Gram staining of sediments after centrifugation is associated with low diagnostic yield. Whether the lysis-centrifugation technique could provide additional value in case of peritonitis with a high likelihood of culture-negative results needs to be evaluated.

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“…Several recent studies have dealt with the conditions necessary for improved diagnosis in CAPD peritonitis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In order to establish accurate microbiological diagnosis of peritonitis, the following points are important: (i) Cultures should be taken as early as possible from suspected cases of peritonitis; the first cloudy bag is the best specimen.…”

Section: Specimenmentioning

confidence: 99%

“…Culturing of large amounts of fluid improved the accuracy of diagnosis ( Fig. 1) (6,11,12). Most methods presently employed incorporate a concentration method (6,7,12), filtration or centrifugation, or the use of blood culture techniques.…”

Section: Culture Proceduresmentioning

confidence: 99%

“…In order to establish accurate microbiological diagnosis of peritonitis, the following points are important: (i) Cultures should be taken as early as possible from suspected cases of peritonitis; the first cloudy bag is the best specimen. A delay of several hours from the time of collection to the time of culture does not seem to decrease the accuracy of bacteriological diagnosis (8); (ii) Large volumes (6,11,12) should be cultured or concentrated for improving recovery rate; (iii) Washing the specimen sediment with sterile saline or using antibiotic removing resin may be necessary in patients already receiving antibiotic therapy (6); and (iv) Identification and sensitivity testing should be done as soon as possible to achieve rational antibiotic therapy (14).…”

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confidence: 99%

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The Diagnosis of Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

Vas

1995

Seminars in Dialysis

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Peritoneal dialysis has developed in the last two decades into an important alternative to hemodialysis in the treatment of end-stage renal failure. Depending on the country, 5%-95% of end-stage renal disease patients entering maintenance therapy select this modality. While the method is still evolving (new osmotic agents, improvement of biocompatibility, etc.), its major hazard and most frequent cause of termination is the development of peritonitis during the treatment. Great improvements have also been made in this area. Peritonitis rates of two per year have been reduced by better connections and better management to 0.5 per year on the average. Still, the early and accurate diagnosis of peritonitis which leads to accurate and effective therapy remains an important part of the management of the continuous ambulatory peritoneal dialysis (CAPD) patient. SpecimenSeveral recent studies have dealt with the conditions necessary for improved diagnosis in CAPD peritonitis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In order to establish accurate microbiological diagnosis of peritonitis, the following points are important: (i) Cultures should be taken as early as possible from suspected cases of peritonitis; the first cloudy bag is the best specimen. A delay of several hours from the time of collection to the time of culture does not seem to decrease the accuracy of bacteriological diagnosis (8); (ii) Large volumes (6,11,12) should be cultured or concentrated for improving recovery rate; (iii) Washing the specimen sediment with sterile saline or using antibiotic removing resin may be necessary in patients already receiving antibiotic therapy (6); and (iv) Identification and sensitivity testing should be done as soon as possible to achieve rational antibiotic therapy (14). Initial Gram StainGram stain from the sediment of the peritoneal dialysis bag establishes the presence of microorganisms only in about 20% to 30% of the cases. This is

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A comparison of four culture methods for diagnosing infection in continuous ambulatory peritoneal dialysis

Cited by 16 publications

References 10 publications

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Continuous Ambulatory Peritoneal Dialysis Peritonitis: Broth Inoculation Culture versus Water Lysis Method

The Diagnosis of Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

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